602 LACTULOSE FOR MINIMAL HEPATIC ENCEPHALOPATHY IN PATIENTS WITH EXTRAHEPATIC PORTAL VEIN OBSTRUCTION: A PILOT STUDY

Abstract

© 2011, INASL 44 AUTOIMMUNE DISEASE AND NON-CIRRHOTIC PORTAL HYPERTENSION Lactulose for Minimal Hepatic Encephalopathy in Patients with Extrahepatic Portal Vein Obstruction—A Pilot Study P Sharma, A Agrawal, BC Sharma, SR Mishra, SK Sarin Department of Gastroenterology, GB Pant Hospital, New Delhi Background and Aims: Minimal hepatic encephalopathy is common in patients with extrahepatic portal vein obstruction (EHPVO). Lactulose is effective in the treatment of MHE in patients with cirrhosis. There is no study on the treatment of MHE using lactulose in patients with EHPVO. Patients and Methods: Consecutive EHPVO patients were assessed by psychometric (number connection test [NCT-A and B], digit symbol test [DST], serial dot test [SDT], line tracing test [LTT]) and critical flicker frequency (CFF) at inclusion. Patients diagnosed as MHE were treated with lactulose and psychometric tests and CFF were reassessed after 3 months. Results: Of 70 patients screened prevalence of abnormal psychometric test were NCT-A (41%), NCT-B (53%), DST (38%), SDT (40%) and LTT (44%). Thirty patients (43%) had two or more than two abnormal psychometry tests. Lactulose improved MHE in 16/30 (53%) of patients after 3 months of treatment. All patients could do CFF with little training. CFF in patients with MHE (n = 30) was significantly lower than those without MHE (n = 40) (38.1 ± 2.4 vs. 41.5 ± 3.1 Hz, p = 0.01). CFF was less than 38 Hz in 21 (70%) of 30 patients before treatment and in 10 (33%) patients after lactulose therapy in MHE patients. All patients could tolerate lactulose without any significant side effects. Four patients (13%) developed transient diarrhea in whom dose need reduction, 3 (10%) did not like its taste but continued, 2 (6%) developed abdominal bloating sensation. Conclusion: Lactulose is effective in the treatment of MHE in patients with EHPVO Conflict of Interest: None Associated HLA Alleles with Pediatric and Adult AIH in North Indian Population RW Minz*, N Kaur*, S Anand*, R Aggarwal*, B Saikia*, YK Chawla** Department of *Immunopathology, **Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh Background and Aims: Autoimmune hepatitis is an unresolving inflammation of liver characterized by presence of hypergammaglobulinemia, autoantibodies and histology showing interface hepatitis. AIH is a polygenetic disorder in which genetic risk factors affect the occurrence, clinical phenotype, severity and disease outcome. The major contributor to genetic susceptibility is the HLA region. This study aimed to find the associated HLA alleles in pediatric AIH and adult AIH. Methods: Twenty pediatric AIH patients and 35 adult AIH patients were enrolled in the study following IAHG guidelines. One hundred twenty-eight healthy controls were also included in the study. The patients and the controls were typed for HLA-DR DQ by PCR–SSP method (Innotrain, Germany). Results: HLA-DRB1*08 was found to be significantly associated with adult AIH and DRB1*03 and DRB1*04 were found to be associated with pediatric AIH. Conclusion: Like other autoimmune diseases, AIH is also associated with HLA genetic susceptibility. Presence of high susceptibility alleles leads to early manifestation of the disease i.e., in childhood age, whereas presence of other associated alleles leads to disease manifestation later in age. However, there are other genetic regions that need to be studied for genetic susceptibility for the disease. Conflict of Interest: None Clinical Profile of Patients with Liver Disease of Autoimmune Etiology R Kavitha*, TM Ramachandran**, T Varghese*** *DM Trainee and Presenting Author,**Additional Professor, ***Professor Department of Gastroenterology, Govt Medical College, Calicut, Kerala Aim: To determine the incidence, clinical, and biochemical profile of autoimmune hepatitis in a tertiary care institution. Methods: Patients presented with acute or chronic liver disease between January 2009 and January 2011 were evaluated. Data was taken retrospectively from data register. Workup included clinical, biochemical, USG, viral markers, autoimmune markers (ANA, SMA, AntiLKM, AMA, RF, p-ANCA) and liver biopsy if possible. AIH was diagnosed using Czaja criteria. Those patients who presented with features of cirrhosis were included since they were evaluated in the past with liver biopsy. 03_JCEH-Abstract.indd 44 3/18/2011 11:13:06 AM